HomeMy WebLinkAboutSeptic Repair 239 Graham dye
Town of South Windsor - Health Department
1540 Sullivan Avenue, South Windsor, CT 06074
Phone: 860-644-2511 ext. 250 Fax: 860-644-7280
APPLICATION FOR APPROVAL TO CONSTRUCT A SUBSURFACE SEWAGE DISPOSAL SYSTEM
� yy Application/Permit#:
To the Director of Health,Town of: 4O O+L% LA)
W:w 4 50r Date: t b' 14— 1
Application is hereby made for an approval to construct a subsurface sewage disposal system for a:
uv-cl
��(sRe��sidential Building,Restaurant,Retail Building,etc.)
located at: 3'q C-X r %- 1�-C
(Street Address,Lot Number,Subdivision Name,Map,Block,Lot,etc.)
New-Systerft.. Addition Repair ^tch
. ,_ .,., r-
Owner !r ytAr _Address U
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' 30l7k:• fTel
Installer Vk t�S Nt4CAJCA!CAddress o� -� r Tel.No, o `d'
�� 3y25
Installer License No.
In accordance with detailed information stated below:
00
Application fee paid 0 Signed
(Owner or duly aut i ed presentative)
------------------------------------------------------------------------------------------------------------------------------ ----
GENERAL INFORMATION
Soil Tests Conducted(Date): Lot size sq.ft.
Area of Special Concern(Y/N): If yes,Reason(s):
Basis of Design(#of Bedrooms,Restaurant Seats,Building Size,etc.): Lp?3, �f OIT�y/
J
Engineered Plan Required(Y/N): If yes,Name of Engineer:
Address of Engineer:
Design Plan Approved(Y/N): Date of Approved Plan: Revision Date:
Type of Water Supply �t CC f well,has location been approved(Y/N):
Well Driller's Name: Address:
OFFICE USE ONLY
Approval to Construct issued by: L&61e, 0 S (�f —Date:--to (� J
(Director of Health or Registered Sanitarian)
Signature: Title:
...............
Septic Repalirfort.. Our Savior Loth an Church 10
Graham Rd. South Windsor 42-15
er
;
860..;-4M9017:(Kenf):
k d hand washing; n . 'ter
Sacristy stric"an. . A ,W shi...g station currently to interior bolding;tan k,
ner t" g.-.a. a
OR ph maxi M.-u m'.of UO;g llonsper week or wj&O,no:sw4ge?
egarbageA posall building on
:no ...b.
.0 -a
,sewers;but.no way -
_.ay to route tet m in plumbing
PrO.Poted: Core rfo. -d- t' all.:VSCHO th wa n t r
vot-a ton,inst ......- .mujO Ili..cap for plumber o, In e iorinstall6trifiltrator.
Quick'4's.with stone f, O.SF.E 2$0. box,
galigo,apraq and monitoring port,fed by a Tuff distribution
ma tin um% into grad
e.wi
ll beaporokli nattily 36" :exact elevation ontobedeterml"tdduri g.! st
alia
tibn
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to
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ape
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t)es4.ned.By.jo.n-a.tth:a.,t,.,t:Sk:I Skipper 'Ski -M ppip- I., p. 40*004O.T.. 0.. s Z1.-C rt -ey:D Ne in to bu...n riv 3425'
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LOCATION _�•�� r �.� TO N: 5a
WCATE ALL PARTS OF SENV AGE DISPOSAL SYSTEM.CURTAIN DRAIN OR FILL. Indicate front or baek of
house,garage,driveway and any other prominent landmark.
a.
T44 %01- k 4i5-AY v)npn 1pqot .
` ra ►�a�t41
seyK. cf vas a
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*L.CfriS "SihZt:: c ►:un:i .c1GSu:a�
Say S sih' , sir
POINT #1 z 14 5 #6 #7 # #9 # o
#3
13is�attcc rrum � i £� � .
corner A 't���3 •�::u� � � �'3i�t
r Vance from 7 �
'corner B I X t J l i � 1 l E
Distartcs frorti { 3.
C I corner `
Distance from E. {
Coiner �} � I
t
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lS.S:U.ILT DIMENSIONS PROVIDED BY : Skips WasbeMlpr Services Date: ��l^A)